A telehealth approach to conducting clinical swallowing evaluations in children with cerebral palsy

• The first study showing the value of telehealth for evaluating pediatric dysphagia.
• Asynchronous clinical swallowing tele-evaluations in children with CP are reliable.
• Inter- and intrarater agreement on dysphagia severity was substantial to excellent.
• Recordings’ quality and pre-training to criterion increase telehealth reliability.

BackgroundAccurate and timely evaluation of dysphagia in children with cerebral palsy (CP) is critical. For children with limited access to quality healthcare, telehealth is an option; however, its reliability needs to be investigated.AimTo test the reliability of an asynchronous telehealth model for evaluating dysphagia in children with CP using a standardized clinical assessment.Methods and proceduresNineteen children (age range 6.9–17.5) were assessed at three mealtimes via the Dysphagia Disorder Survey (DDS) by three clinicians (face-to-face evaluations). Mealtimes were video-recorded to allow asynchronous evaluations by a remote clinician who also completed approximately 1/3 of face-to-face evaluations. Agreement was tested on DDS variables and dysphagia severity.Outcomes and resultsResults revealed substantial to excellent agreement between face-to-face and remote assessments by the same rater (78–100%, KW = 0.64–1) on all, but two variables (oral transport and oral pharyngeal swallow) and by different raters (69–89%, KW = 0.6–0.86) on all but one variable (orienting). For dysphagia severity, intrarater agreement was excellent (100%, KW = 1); interrater agreement was substantial (85%; KW = 0.76).Conclusions and implicationsAsynchronous clinical swallowing evaluations using standardized tools have acceptable levels of agreement with face-to-face evaluations, and can be an alternative for children with limited access to expert swallowing care.